MACRA & You

Medicare Access and CHIP Reauthorization Act (MACRA)

The Centers for Medicare & Medicaid Services (CMS) began implementing the sweeping payment reforms called for under the Medicare Access and CHIP Reauthorization Act (MACRA) in 2017. Year 3 of the program began January 1, 2019.

MACRA repeals the sustainable growth rate (SGR) formula and creates the Quality Payment Program (QPP) that rewards physicians and clinicians for giving better care, not just more care.

Under the QPP, clinicians can report quality metrics through two tracks:

Eligibility and Requirements

Beginning with Performance Year 2019, the low volume threshold includes (1) Allowed charges (2) Number of beneficiaries who receive services; and (3) Number of services provided. Clinicians fall under the low-volume threshold and receive an exemption from MIPS if they: 

  • Bill $90,000 or less in Medicare Part B allowed charges for covered professional services payable under the Physician Fee Schedule; or
  • Provider covered professional services for 200 or fewer Part B-enrolled individuals; or
  • Provide 200 or fewer covered professional services to Part B-enrolled individuals.

An Advanced APM lets practices earn more for taking on risk related to their patients' outcomes. To be an advanced APM, the following requirements must be met:

  • Require participants to use certified electronic health record technology (CEHRT)
  • Provide payment for covered professional services based on quality measures comparable to those used in the quality performance category of MIPS
  • Either be a Medical Home Model expanded under CMS Innovation Center authority; or require participating APM Entities to bear more than a nominal amount of financial risk for monetary losses.

Do you need to report? Determine your QPP eligibility.

Advocacy

The Centers for Medicare & Medicaid Services (CMS) routinely publish Requests for Information and additional Federal Regulatory Rules that affect participants of the program. Read more about ASA's positions on important issues.

MACRA Acronyms

We've composed a helpful guide that translates acronyms and terms related to or part of MACRA. View the full list of MACRA acronyms.

More Solutions & Resources

Get started with the ASA resources below. You can also find CMS Resources here and ASA FAQs here for all things MACRA.